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Transcript of final comprehensive study-1
Comprehensive Study
of
Paranoid Schizophrenia
Submitted by:
Lazarte, Mary Rose
Libarnes, Noemibelle
Lim, Ludivina
Lingad, Patricia Shane
Lingad, Diovi Alyssa
Ludovico, Aira Joy
Macalinao, Rence Maricon
Macalinao, May Ann
Macaraeg, May
Martinez, Sheila Mae
Venturina, Lloribel
Magallanes, Mc Charles
Malanum, Jeffry
Malanum, Sergio Paolo
1
Group P
Submitted to:
Nemia de Leon-Calimbas, RN MAN
Clinical Instructor
Acknowledgement
We would like to extend our deepest gratitude to all those who made this
Comprehensive Case Study possible.
First and foremost, to our almighty God, for the spiritual guidance and blessing
given to us for the whole exposure to the institution. Every task and conflict faced is
treated with gratitude as it strengthen our faith and self-concept.
Second, to our beloved and hardworking parents, for the financial needs and
unconditional love. The continuous support and encouragement given served as
inspirations and motivation directed towards achieving the goals and objectives to the
exposure.
Third, to our very energetic and enthusiastic Clinical Instructors, Ma’am Nemia
D. Calimbas, Sir Ronald Tyron dela Rosa and Sir Irish Flores. Thank you for knowledge,
guidance, enthusiasm and patience you have given during our duty at Mariveles Mental
Hospital.
Fourth, to all the staffs of Mariveles Mental Ward, for the warm welcome and
accommodation during our duty. We thank the institute for allowing the group to
maximize their facilities.
Lastly, to our patients especially Mr. A.C.T. for cooperating with us while we
were having a daily conversation to get all the necessary data we needed on our case
study.
Thank you very much and God bless!!!
Dedication
We would like to dedicate this Comprehensive Case Study to our energetic,
bubbly, enthusiastic, and smart Clinical Instructor Ma’am Nemia D. Calimbas, RN,MAN
for her willingness to impart her knowledge to us .To Sir Ronald Tyron dela
Rosa,RN,MAN for his humor, workmanship and simple jokes that made us enjoy and
learn so much. To Sir Irish Flores, RN who supervised us in our duty at Mariveles Mental
Ward. We will owe you a lot for this and we will never forget our mentors who broaden
our knowledge in psychiatric nursing and inspired us to become successful registered
nurses in the near future.
TABLE OF CONTENTS
Acknowledgement
Dedication
Table of Contents
UNIT 1 …………………………………………………………….
Introduction
Personal Data
Chief Complaints
History of present Illness
Past Personal History
Family History
UNIT 2 ……………………………………………………………
Mental Status Assessment/ Analysis and Interpretation
UNIT 3 …………………………………………………………….
Psychopathology
Related Literature and Studies
UNIT 4 …………………………………………………………….
Nursing Care Plans
Pharmacology
UNIT 5 ……………………………………………………………
Psychotherapy
UNIT 6 ……………………………………………………………
Glossary
UNIT 7 ……………………………………………………………
References
UNIT 8 …………………………………………………………….
Documentation
UNIT 1
Introduction
Paranoid schizophrenia is the most common type of schizophrenia in most parts
of the world. The clinical picture is dominated by relatively stable, often paranoid,
delusions, usually accompanied by hallucinations, particularly of the auditory variety,
and perceptual disturbances. Disturbances of affect, volition, and speech, and catatonic
symptoms, are not prominent.
With paranoid schizophrenia, your ability to think and function in daily life may
be better than with other types of schizophrenia. You may not have as many problems
with memory, concentration or dulled emotions. Still, paranoid schizophrenia is a serious,
lifelong condition that can lead to many complications, including suicidal behavior.
(http://www.mayoclinic.com/health/paranoid-schizophrenia/DS00862)
Patients who have paranoid schizophrenia that has thought disorder may be
obvious in acute states, but if so it does not prevent the typical delusions or hallucinations
from being described clearly. Affect is usually less blunted than in other varieties of
schizophrenia, but a minor degree of incongruity is common, as are mood disturbances
such as irritability, sudden anger, fearfulness, and suspicion. "Negative" symptoms such
as blunting of affect and impaired volition are often present but do not dominate the
clinical picture.
The course of paranoid schizophrenia may be episodic, with partial or complete
remissions, or chronic. In chronic cases, the florid symptoms persist over years and it is
difficult to distinguish discrete episodes. The onset tends to be later than in the
hebephrenic and catatonic forms. (http://www.schizophrenia.com/szparanoid.htm)
According to the World Health Organization, It describes statistics about mental
disorders of year (2008). Schizophrenia is a severe form of mental illness affecting about
7 per thousand of the adult population, mostly in the age group 15-35 years. Though the
incidence is low (3-10,000), the prevalence is high due to chronicity. According to the
facts it reveals Schizophrenia affects about 24 million people worldwide. Schizophrenia
is a treatable disorder, treatment being more effective in its initial stages. More than 50%
of persons with schizophrenia are not receiving appropriate care.90% of people with
untreated schizophrenia are in developing countries. Care of persons with schizophrenia
can be provided at community level, with active family and community involvement.
Schizophrenia affects men and women with equal frequency. Schizophrenia often
first appears in men in their late teens or early twenties. In contrast, women are generally
affected in their twenties or early thirties.
In the U.S., mental disorders are diagnosed based on the Diagnostic and Statistical
Manual of Mental Disorders, fourth edition (DSM-IV).
(http://www.howstuffworks.com/framed.htm?parent=schizophrenia.htm&url=http://
www.nimh.nih.gov/health/publications/the-numbers-count-mental-disorders-in-
america.shtml)
In the Philippine setting, the disability survey done in 2000 by the National
Statistics Office (NSO) found out that mental illness was the 3rd most common form of
disability in the country. The prevalence rate of mental disorders was 88 cases per
100,000 population and was highest among the elderly group. This finding was supported
by a more recent data from the Social Weather Station Survey commissioned by DOH in
2004. It reveals that 0.7 percent of the total households have a family member afflicted
with mental disability. The Baseline Survey for the National Objectives for Health in
2000 stated that the more frequently reported symptoms of an underlying mental health
problem were sadness, confusion, forgetfulness, no control over the use of cigarettes and
alcohol, and delusions.
The most recent study on the prevalence of mental health problems was
conducted by the National Epidemiology Center (DOH-NEC) in 2006 which showed
revealing results though the target population was limited only to government employees
from the 20 national agencies in Metro Manila. Among 327 respondents, 32 percent were
found to have experienced a mental health problem at least once in their lifetime. The
three most prevalent diagnoses were: specific phobias (15 %), alcohol abuse (10%),
depression and schizophrenia (6%). Mental health problems were significantly associated
with the following respondent characteristics: ages 20-29 years, those who have big
families, and those who had low educational attainment. The prevalence rate generated
from the survey was much higher than those that were previously reported by 17 percent
(www.doh.gov.ph).
Currently, there is no method for preventing schizophrenia and there is no cure.
Minimizing the impact of disease depends mainly on early diagnosis and, appropriate
pharmacological and psycho-social treatments. Hospitalization may be required to
stabilize ill persons during an acute episode. The need for hospitalization will depend on
the severity of the episode. Mild or moderate episodes may be appropriately addressed by
intense outpatient treatment. A person with schizophrenia should leave the hospital or
outpatient facility with a treatment plan that will minimize symptoms and maximize
quality of life.
This introduced psychiatric case was chosen primarily because it is the most
interesting amongst the cases that were encountered by the group members. It posts
relevant manifestations that are psychiatric in nature and the entire case is highly possible
to be studied comprehensively within the limited time available.
Personal Data
Name : Mr. A. T.
Address : Arayat, Pampanga
Civil Status : Single
Birth Date : December 24, 1956
Father : Gonzalo Tungol (deceased)
Mother : Lourdes Tungol
Highest Educational Attainment : Second year high school
Admission : October 19, 2009
Physician Attended : Dr. Reyes
Date Furnished by : Merlinda Bernandino
Chief Complaints
Sleepless
Talkative
Refused Medication
Broke glasses and plates
Health History
a. Past Health History
Client was discharged from MMH last January 2009. He refused to report
for check up and refused to the medicines. He threw his medications but this was
tolerated by his family.
By March 5, 2009, his elderly mother passed away due to medical
condition of heart disease which was blamed to patient’s condition. Patient’s
condition worsens and he was noted to talked aloud and speak as is talking to
someone. He was also noted to become irritable and potentially harmful. He was
placed in jail and referred here at MMH for evaluation and management. He had 5
previous admissions at MMH. The last time was from May 20-August 25, 2009.
Two days after his discharge, he was noted to have shallow sleep and was caught
hoarding the medication.
b. Present Health History
Based from client’s chart, he smoked heavily and would harm his siblings
who refused to give him cigarette. He refused to have followed up check-ups at
JBL.
He walked aimlessly even at night and was tolerated as the family are
afraid at him. One week, he rushed stairs at neighbors prompting the family to
bring him for evaluation in management.
On the first day of handling our client he looked depressed but it doesn’t
show because he always smiled at us and seemed to be ok. He didn’t show signs
and symptoms of mental illness but when we talked to him you’ll see that there’s
a problem with him. Based on his statements, he always utter events that are
impossible to happen such “Uulan ng apoy sa Pebrero 21 taong 2030”,
“Mabubuhay ulit ang mga magulang ko makalipas ang 2 taon”, “May nakikita
akong mga taong nakatira sa araw”.
Based on the chart:
General appearance, behavior and attitude: Adult, male
Mood and Affect: Congruent, poor grooming
Stream of Talk: Congruent
Content of thought: Responsive to irrelevant ideas
Assessment: Paranoid Schizophrenia
c. Family History
According to him, the client belongs to low socio economic status. They
have no any properties but lives through plowing vegetables such as eggplant,
carrots and etc.
According to his sister, they have a history of mental illnesses and five of
his siblings are also suffering from the said condition.
d. Social History
a. Childhood
The client is the eldest from the eleven siblings of Mr. Gonzalo
Tungol and Mrs. Lourdes Tungol. Since he was a child he is fond of
plowing vegetables, and seems to be contented with what they have. On
his elementary days, he was an active student in their class. He always
participates in class activities.
b. Adolescence
According to him, he started smoking and drinking emperador in
his teen age life. He verbalized that he always treats his friends when they
go outside for fun. There came a time that his friends left him because his
friends envied him.
c. Adulthood
According to him, he worked at Manila as a helper and then he was
lucky to have an opportunity to work abroad at the age of 22 at Saudi
Arabia for 3 years. Upon his return he managed to buy a karaoke for his
girlfriend and tricycle for his family also a 45 days chicken for his mother.
He also verbalized that he was hit by a jeep and he blamed his cousin for
this incident.
e. Sexual History
Upon interview, the client verbalized that he feels disappointed of
not having family but then he got contented for taking care of his nephews
but if he will be given a chance to have a family, he will be prefer to have
a small family with a loving wife. For him having a wealthy family is not
important but for him what important is having a happy and loving family.
UNIT III
Psychopathophysiology of Paranoid Schizophrenia
Death of a Loved One
Denial and depression
Need for love and belongingness
Grieving
Disruption of Self-Concept and Physiologic Functioning
In relation to Dorothy Johnson’s Behavioral System Model, individuals maintain
stability and balance through adjustments and adaptation to the forces that interferes
them. Death is an inevitable part of life. But those left behind undergoes a long and
complex process of grieving and coping. In the process of grieving, the individual needs
love and belongingness primarily from the family and friends who will support and guide
him. And if unmet, denial and depression will develop and prevent the individual from
dealing with the loss. Instead of acceptance and full recovery to physiologic function, the
self-concept of the individual is disrupted leading to different physiologic, social,
emotional and even mental conditions. It is by these coping mechanisms that the
individual may go back to normal functioning and without these; one may not be able to
accept the loss, move on and go back to reality.
In line with this, Nancy Roper, WW. Logan and A.J. Tierney’s Model for Nursing
based on a model of living explains that most individuals experience significant life
events which can affect activities of living causing actual and potential problems. Similar
to the case of the client, he experienced death of a loved one which primarily caused his
readmission to the institute. The event affected his independence towards living. The
individual became reliant to family and friends. And when his needs were unmet, his
activities of living were malformed thus disrupting his self-concept. Here is where the
nursing profession comes in, nursing helps to maintain the individuality of person by
preventing potential problems, solving actual problems and helping to cope.
Psychopathophysiology of Paranoid Schizophrenia
Separation from Family
Need for love and belongingness
Unsuccessful relationship with the opposite sex
Seeking for secondary sources
Development of depression and feeling of not wanted
Denial, confusion and self-pity
Psychopathophysiology of Paranoid Schizophrenia
Death of a Loved One
Family placed blame on client
Denial and depression
Having hallucinations of talking to someone
Withdrawal and detachment to society
Psychopathophysiology of Paranoid Schizophrenia
Maslow's hierarchy of needs is predetermined in order of importance. It is often
depicted as a pyramid consisting of five levels: the first lower level is being associated
with physiological needs, while the top levels are termed growth needs associated with
psychological needs. Deficiency needs must be met first. Once these are met, seeking to
satisfy growth needs drives personal growth. The higher needs in this hierarchy only
come into focus when the lower needs in the pyramid are met. Once an individual has
moved upwards to the next level, needs in the lower level will no longer be prioritized. If
Low-Socioeconomic Status
Deficiency in meeting sufficient needs and maintaining health
Limited access to health care
Disruption of health status
Alteration in physiologic function
Ineffective coping mechanisms
a lower set of needs is no longer being met, the individual will temporarily re-prioritize
those needs by focusing attention on the unfulfilled needs, but will not permanently
regress to the lower level.
According to Sister Callista Roy’s Adaptation Model, an individual is a
biopsychosocial adaptive system within an environment. In the client’s case, the need for
love and belongingness is not achieved, so he resorted to seek for alternative resources
such as having a relationship with the opposite sex. Whenever a need is unmet, an
individual adapts to the deprived environment so as to meet the needs in other means.
The client needs to have a positive self-concept and self-awareness in order to be fully
functional and productive.
Psychopathophysiology of Paranoid Schizophrenia
Low Educational Attainment
Minimal exposure to society(peers and student body)
Limited development of physiologic capability, problem solving skills and social skills
Ineffective coping strategies and maladaptation
Alteration to Self-Concept
Self-Inferiority
Neuman sees health as being equated with wellness. She defines health/wellness
as "the condition in which all parts and subparts (variables) are in harmony with the
whole of the client (Neuman, 1995)". As the person is in a constant interaction with the
environment, the state of wellness (and by implication any other state) is in dynamic
equilibrium, rather than in any kind of steady state. Neuman proposes a wellness-illness
continuum, with the person's position on that continuum being influenced by their
interaction with the variables and the stressors they encounter. The client system moves
toward illness and death when more energy is needed than is available. The client system
moves toward wellness when more energy is available than is needed. Since the client
has minimal exposure to the society, using Neuman’s theory, this could explain why the
client has become ill.
According to Roy’s Adaptation Model, adaptive responses promotes integrity in
terms of the goals of the human system, that is, survival, growth, reproduction, mastery,
and personal and environmental transformation. In this case, if the client would adapt
physically, emotionally, psychologically and socially, then there is a possibility that the
client would attain wellness.
Related Literatures and Studies
Perspectives of Mental Illness Vary With Cultural Backgrounds?
Recently, treatment of mental illness has shifted toward a collaborative effort
between patient and practitioner. As a result, the understanding of a patient's perspective
on his or her illness is essential to treatment. The study attempts to understand the
different cultural backgrounds of patients and how they influence their unique
perspectives of their illnesses. The goal is to aid the treatment of mental illness through a
deeper understanding of patients and their diverse cultural backgrounds.
I agree to this study because it is vital to understand the client as an individual, a
member of the society and a rational human being. There are different predisposing
factors towards development of any mental illness, paranoid schizophrenia for example.
In order to maintain and control an illness, the risk factors and stimulus must be removed
the system to allow rehabilitation and development of self-concept and function.
It is important to have this kind of studies in order to correct, support and provide
information from the previous studies. Also, this improvement in the recent studies
proves that there are other ways to treat and evaluate mental illnesses.
Schizophrenia Risk Genes Affect Even Healthy Individuals
Dr. Stefanis, explaining the importance of this study, comments that "these
findings support the notion that even at the general population level, the genetic liability
to psychosis may be expressed as minute and 'undetected to the naked eye' alterations in
brain information processing capacity and behavior." Dr. Krystal adds, "Consistent with a
growing body of evidence, this study suggests that there may be subtle cognitive
impairments that are present when these common risk gene variants are present in the
general population." Clearly, these findings will have an important impact on the future
genetic work in this area.
I agree to this study since heredity and genetics served as primary risk factors.
There are conditions like mental illnesses that occur physiologically. This study is
important in order to assess and estimate the number of population at risk of developing
the said condition. Also, there has been past studies proving the relation of genetics to the
development of the illness and this study would prove it, increasing the chance of
developing managements and treatment even prevention of acquiring the condition which
is a huge help to the nursing profession whereas, prevention of illnesses and promotion of
health is the main goal.
Schizophrenia
Schizophrenia is a chronic, severe and disabling brain disease. Approximately 1
percent of the population develops the condition during their lifetime. People with
schizophrenia often suffer terrifying symptoms such as hearing internal voices not heard
by others, or believing that other people are reading their minds, controlling their
thoughts, or plotting to harm them. These symptoms may leave them fearful and
withdrawn. Their speech and behaviour can be so disorganized that they may be
incomprehensible or frightening to others. This is a time of hope for people with
schizophrenia and their families.
In my opinion, many studies have been done to uplift the treatment and the
process of rehabilitation. However, the individual with schizophrenia on continuous or
recurring pattern of illness often does not fully recover normal function and typically
requires long-term treatment, generally including medication, to control the symptoms.
There are many researches that are gradually leading to new and safer medication
and unravelling the complex causes of the disease. Methods of imaging the brain’s
structures and function hold the promise of new insights into the disorder. This is
important to the nurse’s profession in order to understand in detail the condition and be
able to give appropriate management towards rehabilitation.
Fish Oil as a Preventive Medication to Schizophrenia
The study is about the beneficial effects of Fish Oil to the prevention of the
condition in those at risk to mind altering disease. The study was a randomized control
trial conducted on Australia to those who had experienced brief hallucination/ delusions
between the ages of 15 and 25 years old. For three months period, one half of the group
received approximately 1.5 grams of a fish oil capsule while the remaining members
received placebo.
I do agree with the said research since upon researches and experiments done. It
finds out that fish oil have higher tendency of preventing mental illness specifically
schizophrenia. And fish oil has its medical effect rather than giving placebo effect
thereby inducing greater tendency of developing psychosis. As cited by the DOH,
“prevention is better than cure”. Early prevention can cure only this kind of illness early.
Fish oil have no known side effect and also proven healthy based from other researches
conducted.
As a nurse, this is important because alternative medication can be found in nature
and not purely chemically engineered medications. This can be offered in a lower cost
and can be easily acquired.
Schizophrenia and a Handful of medications forever
Schizophrenia is a scary and difficult chronic mental illness both for the person
and for the family who all have to live with the diagnosis. In most cases, antipsychotic
medications need to be taken forever to control the disturbing symptoms but rarely is
anyone told that these medication not only double the risk of sudden cardiac death but
also put the suffer at risk for several other chronic illnesses as well.
Personally, I disagree in a sense that I had to experience wherein I have seen the
patient that stayed in the mental institution for three years and was able to recover . when
I asked him about his condition right now, he said that he is okay and he is not suffering
from any fatal diseases in which this article talks about.
We as the health care providers, it will give us enough information about the
“real” effects of the medications that we are supposed to give to the clients. And this
article will enable us to be knowledgeable enough to any pharmaceutical products.
NAME OF DRUG MECHANISM
OF ACTION
INDICATIONS CONTRAINDICATIONS SIDE
EFFECTS
ADVERSE
EFFECTS
NURSING
CONSIDERATIONS
GENERIC NAME:
Clonazepam
BRAND NAME:
Clonapam
CLASSIFICATION
Anti-convulsant
DOSAGE:
0.5mg three times a
day
•Benzodiazepin
e derivative w/c
increasing
presynaptic
inhibition and
suppresses the
spread of
seizure activity.
•Some
effectiveness in
absence
seizures
resisters to
succinimide
therapy.
•Sensitivity to
benzodiazepine
•Severe liver disease,acute
narrow-angle glaucoma
•Pregnancy
•Sedation
•Weakness
•Headache
•Vomiting
•Muscle cramping
•Insomnia
•Do not confuse
Klonopin w/ clonidine
(anti-hypertensive)
•Assess drug effects
before performing
activities that require
mental alertness.
•Take as directed, report
any loss of seizure
control or adverse effect
NAME OF DRUG MECHANISM INDICATION CONTRAINDICATION SIDE ADVERSE NURSING
OF ACTION EFFECTS EFFECTS CONSIDERATIONS
GENERIC NAME:
Diphenhydramine
BRAND NAME:
Benadryl
CLASSIFICATION:
Anti-histamine
DOSAGE:
50mg three times a
day
•High
sedative ,antich
olinergic,and
antiemetic
effects.
•Diphenhydramin
e is used for the
relief of nasal and
non-nasal
symptoms of
various allergic
conditions such as
seasonal allergic
rhinitis. It is also
used to alleviate
cold symptoms
and chronic
urticaria (hives).
•Topically to treat
chickenpox
•Poison ivy or sunburn.
•Nausea
•Sleepiness
•Tirediness
•Hypertension
•Tremor
•Glaucoma
•Hyperthyroidism
•Do not confuse
diphenhydramine w/
pesipramine (anti-
depressant) or
dimenhydrinate(antihista
mine).
•Use sun protection;may
cause photosensitivity
reaction.
•Use sugarless
gum/candy to diminish
dry mouth effects.
NAME OF DRUG MECHANISM INDICATION CONTRAINDICATION SIDE ADVERSE NURSING
OF ACTION EFFECTS EFFECTS CONSIDERATIONS
GENERIC NAME:
Haloperidol
BRAND NAME:
Haldol
CLASSIFICATION:
Anti-psychotic
DOSAGE:
2mg two-three times
a day
•Competitively
blocks
dopamine
receptors in the
tuberoinfundibu
lar system to
cause sedation.
•Haloperidol is used
to treat symptoms of
certain types of
mental conditions
(e.g., schizophrenia);
to control movements
or effects of
Tourette's syndrome;
or to control severe
behavioral problems
in children.
•Use w/ extreme
caution,or not at all,in
clients w/ parkinsonism.
•Dry mouth
•Headache
•Nausea
•Drowsiness
•Dizzines
•Vomiting
•Do not confuse Haldol
w/ Medrol (a
corticosteroid)
•Use w/ caution in
elderly;they tend exhibit
toxicity more frequently.
•Assess
CBC,electrolytes,liver
and renal function.
UNIT IV
NURSING CARE PLANS
UNIT V
PSYCHOTHERAPY
UNIT VI
Glossary
Affect – the outward expression of the client’s emotional state
Agnosia – inability to recognize or name objects despite intact sensory abilities
Akathisia – intense need to move about; characterized by restless movement, pacing, inability to
remain still, and the client’s report of inner restlessness.
Anhedonia – having no pleasure or joy in life; losing any sense of pleasure from activities
formerly enjoyed.
Aphasia – deterioration of language function
Apraxia – impaired ability to execute motor functions despite intact motor abilities
Blunted Affect – showing little or a slow-to-respond facial expression; few observable facial
expression
Concrete Thinking – when the client continually gives literal translations; abstraction is
diminished or absent
Delusion – a fixed, false belief not based in reality
Denial – defense mechanism; clients may deny directly having any problems or may minimize
the extent of problems or actual substance use.
Dissociation –a subconscious defense mechanism that helps a person protect his or her
emotional self from recognizing the full effects of some horrific or traumatic event by allowing
the mind to forget or remove itself from the painful situation or memory
Echolalia – repetition or imitation of what someone else says; echoing what is heard
Echopraxia – imitation of the movements and gestures of someone an individual is observing
Extrapyramidal Side Effects –reversible movement disorders induced by antipsychotic or
neuroleptic medication
Fear – feeling afraid or threatened by a clearly, identifiable, external stimulus that represents
danger to the person
Flat Affect – showing no facial expression
Flight of Ideas –excessive amount and rate of speech composed of fragmented or unrelated
ideas; racing, often unrelated thoughts
Inappropriate Affect – displaying a facial expression that is incongruent with mood or
situation; often silly or giddy regardless of circumstances.
Labile – rapidly changing or fluctuating, such as someone’s mood or emotions
Neologisms – invented words that have meaning only for the client
Repressed Memories – memories that are buried deeply in the subconscious mind or repressed
because they are too painful for the victim to acknowledge; often relate to childhood abuse
Tardive Dyskinesia – a late-onset, irreversible neurologic side effect of antipsychotic
medications; characterized by abnormal, involuntary movements such as lip smacking, tongue
protrusion, chewing, blinking, grimacing, and choreiform movements of the limbs and feet.
Therapeutic Communication – an interpersonal interaction between the nurse and client during
which the nurse focuses on client’s specific needs to promote an effective exchange of
communication
Therapeutic Nurse-Client Relationship – professional, planned relationship between client and
nurse that focuses on client needs, feelings, problems and ideas; interaction designed to promote
client growth, discuss issues, and resolve problems; includes the three phases of orientation,
working and termination
Therapeutic Relationship – see nurse-client relationship
Word Salad – flow of unconnected words that convey no meaning to the listener
Working Phase – in the therapeutic , the phase where issues are addressed, problems identified,
solutions explored; nurse and client work to accomplish goals; contains Peplau’s phases of
problem identification and exploitation.
UNIT VII
References
Books
Videbeck, Sheila L., Psychiatric Mental Health Nursing, 3rd edition
Elizabeth, Manual of Psychiatric Nursing Care Plan
BPSU-CNM, NCM 103
Balita, Carl E., Ultimate Learning Guide to Nursing Review, 2008 ed.
Websites
www.mayoclinic.com
www.naturalnews.com
www.schizophrenia.com
www.howstuffworks.com
www.doh.gov.ph
UNIT VIII
DOCUMENTATION